Out-of-Field Doses Produced by a Proton Scanning Beam Inside Pediatric Anthropomorphic Phantoms and Their Comparison With Different Photon Modalities.

Since 2010, EURADOS Working Group 9 (Radiation Dosimetry in Radiotherapy) has been involved in the investigation of secondary and scattered radiation doses in X-ray and proton therapy, especially in the case of pediatric patients. The main goal of this paper is to analyze and compare out-of-field neutron and non-neutron organ doses inside 5- and 10-year-old pediatric anthropomorphic phantoms for the treatment of a 5-cm-diameter brain tumor. Proton irradiations were carried out at the Cyclotron Centre Bronowice in IFJ PAN Krakow Poland using a pencil beam scanning technique (PBS) at a gantry with a dedicated scanning nozzle (IBA Proton Therapy System, Proteus 235). Thermoluminescent and radiophotoluminescent dosimeters were used for non-neutron dose measurements while secondary neutrons were measured with track-etched detectors. Out-of-field doses measured using intensity-modulated proton therapy (IMPT) were compared with previous measurements performed within a WG9 for three different photon radiotherapy techniques: 1) intensity-modulated radiation therapy (IMRT), 2) three-dimensional conformal radiation therapy (3D CDRT) performed on a Varian Clinac 2300 linear accelerator (LINAC) in the Centre of Oncology, Krakow, Poland, and 3) Gamma Knife surgery performed on the Leksell Gamma Knife (GK) at the University Hospital Centre Zagreb, Croatia. Phantoms and detectors used in experiments as well as the target location were the same for both photon and proton modalities. The total organ dose equivalent expressed as the sum of neutron and non-neutron components in IMPT was found to be significantly lower (two to three orders of magnitude) in comparison with the different photon radiotherapy techniques for the same delivered tumor dose. For IMPT, neutron doses are lower than non-neutron doses close to the target but become larger than non-neutron doses further away from the target. Results of WG9 studies have provided out-of-field dose levels required for an extensive set of radiotherapy techniques, including proton therapy, and involving a complete description of organ doses of pediatric patients. Such studies are needed for validating mathematical models and Monte Carlo simulation tools for out-of-field dosimetry which is essential for dedicated epidemiological studies which evaluate the risk of second cancers and other late effects for pediatric patients treated with radiotherapy.

Out-of-field doses in pediatric craniospinal irradiations with 3D-CRT, VMAT, and scanning proton radiotherapy: A phantom study.

PURPOSE: Craniospinal irradiation (CSI) has greatly increased survival rates for patients with a diagnosis of medulloblastoma and other primitive neuroectodermal tumors. However, as it includes exposure of a large volume of healthy tissue to unwanted doses, there is a strong concern about the complications of the treatment, especially for the children. To estimate the risk of second cancers and other unwanted effects, out-of-field dose assessment is necessary. The purpose of this study is to evaluate and compare out-of-field doses in pediatric CSI treatment using conventional and advanced photon radiotherapy (RT) and advanced proton therapy. To our knowledge, it is the first such comparison based on in-phantom measurements. Additionally, for out-of-field doses during photon RT in this and other studies, comparisons were made using analytical modeling. METHODS: In order to describe the out-of-field doses absorbed in a pediatric patient during actual clinical treatment, an anthropomorphic phantom, which mimics the 10-year-old child, was used. Photon 3D-conformal RT (3D-CRT) and two advanced, highly conformal techniques: photon volumetric-modulated arc therapy (VMAT) and active pencil beam scanning (PBS) proton RT were used for CSI treatment. Radiophotoluminescent and poly-allyl-diglycol-carbonate nuclear track detectors were used for photon and neutron dosimetry in the phantom, respectively. Out-of-field doses from neutrons were expressed in terms of dose equivalent. A two-Gaussian model was implemented for out-of-field doses during photon RT. RESULTS: The mean VMAT photon doses per target dose to all organs in this study were under 50% of the target dose (i.e., <500 mGy/Gy), while the mean 3D-CRT photon dose to oesophagus, gall bladder, and thyroid, exceeded that value. However, for 3D-CRT, better sparing was achieved for eyes and lungs. The mean PBS photon doses for all organs were up to three orders of magnitude lower compared to VMAT and 3D-CRT and exceeded 10 mGy/Gy only for the oesophagus, intestine, and lungs. The mean neutron dose equivalent during PBS for eight organs of interest (thyroid, breasts, lungs, liver, stomach, gall bladder, bladder, prostate) ranged from 1.2 mSv/Gy for bladder to 23.1 mSv/Gy for breasts. Comparison of out-of-field doses in this and other phantom studies found in the literature showed that a simple and fast two-Gaussian model for out-of-field doses as a function of distance from the field edge can be applied in a CSI using photon RT techniques. CONCLUSIONS: PBS is the most promising technique for out-of-field dose reduction in comparison to photon techniques. Among photon techniques, VMAT is a preferred choice for most of out-of-field organs and especially for the thyroid, while doses for eyes, breasts, and lungs are lower for 3D-CRT. For organs outside the field edge, a simple analytical model can be helpful for clinicians involved in treatment planning using photon RT but also for retrospective data analysis for cancer risk estimates and epidemiology in general.

Radioprotective properties of food colorant sodium copper chlorophyllin on human peripheral blood cells in vitro.

Sodium copper chlorophyllin (CHL) is a food colorant that exhibits many beneficial properties, including potential for use in radiotherapy. Nevertheless, genotoxicity studies investigating radioprotective properties against γ-radiation on human cells are rather scarce. The aim of this study was to assess the cytotoxicity, genotoxicity and induction of malondialdehyde formation on CHL pre-treated whole blood cells after an absorbed dose of 5 Gy γ-radiation. Irradiated whole blood cells pre-treated with 100, 500, and 1000 µg/mL CHL showed less DNA-strand breaks (10.92 ± 0.74%, 10.69 ± 0.68%, and 8.81 ± 0.69%, respectively) than untreated irradiated cells (12.58 ± 0.88%). At the same time, the level of malondialdehyde was lower in CHL pre-treated samples with 100, 500, and 1000 µg/mL CHL (14.11 ± 0.43, 16.35 ± 2.82, and 13.08 ± 1.03 µmol/L, respectively) compared to untreated irradiated samples (24.11 ± 0.25 µmol/L). Regarding cytotoxicity, no changes were observed in the samples tested. Another important finding is that CHL had no cyto/genotoxic properties toward human blood cells. Taken together, since CHL had no cyto/genotoxic effects and showed good radioprotective properties in human blood cells, further studies should be conducted in order to find its possible application in radiotherapy.

OUT-OF-FIELD DOSES IN CHILDREN TREATED FOR LARGE ARTERIOVENOUS MALFORMATIONS USING HYPOFRACTIONATED GAMMA KNIFE RADIOSURGERY AND INTENSITY-MODULATED RADIATION THERAPY.

The purpose of this study was to measure out-of-field organ doses in two anthropomorphic child phantoms for the treatment of large brain arteriovenous malformations (AVMs) using hypofractionated gamma knife (GK) radiosurgery and to compare these with an alternative treatment using intensity-modulated radiation therapy (IMRT). Target volume was identical in size and shape in all cases. Radiophotoluminescent (RPL), thermoluminescent (TL) and optically stimulated luminescent (OSL) dosimeters were used for out-of-field dosimetry during GK treatment and a good agreement within 1-2% between results was shown. In addition, the use of multiple dosimetry systems strengthens the reliability of the findings. The number of GK isocentres was confirmed to be important for the magnitude of out-of-field doses. Measured GK doses for the same distance from the target, when expressed per target dose and isocentre, were comparable in both phantoms. GK out-of-field doses averaged for both phantoms were evaluated to be 120 mGy/Gy for eyes then sharply reduced to 20 mGy/Gy for mandible and slowly reduced up to 0.8 mGy/Gy for testes. Taking into account the fractionation regimen used to treat AVM patients, the total treatment organ doses to the out-of-field organs were calculated and compared with IMRT. The eyes were better spared with GK whilst for more distant organs doses were up to a factor of 2.8 and 4 times larger for GK compared to IMRT in 5-year and 10-year old phantoms, respectively. Presented out-of-field dose values are specific for the investigated AVM case, phantoms and treatment plans used for GK and IMRT, but provide useful information about out-of-field dose levels and emphasise their importance.

Report of IRPA task group on the impact of the eye lens dose limits.

In 2012 IRPA established a task group (TG) to identify key issues in the implementation of the revised eye lens dose limit. The TG reported its conclusions in 2013. In January 2015, IRPA asked the TG to review progress with the implementation of the recommendations from the early report and to collate current practitioner experience. This report presents the results of a survey on the view of the IRPA professionals on the new limit to the lens of the eye and on the wider issue of tissue reactions. Recommendations derived from the survey are presented. This report was approved by IRPA Executive Council on 31 January 2017.

A descriptive and broadly applicable model of therapeutic and stray absorbed dose from 6 to 25 MV photon beams.

PURPOSE: To develop a simple model of therapeutic and stray absorbed dose for a variety of treatment machines and techniques without relying on proprietary machine-specific parameters. METHODS: Dosimetry measurements conducted in this study and from the literature were used to develop an analytical model of absorbed dose from a variety of treatment machines and techniques in the 6 to 25 MV interval. A modified one-dimensional gamma-index analysis was performed to evaluate dosimetric accuracy of the model on an independent dataset consisting of measured dose profiles from seven treatment units spanning four manufacturers. RESULTS: The average difference between the calculated and measured absorbed dose values was 9.9% for those datasets on which the model was trained. Additionally, these results indicate that the model can provide accurate calculations of both therapeutic and stray radiation dose from a wide variety of radiotherapy units and techniques. CONCLUSIONS: We have developed a simple analytical model of absorbed dose from external beam radiotherapy treatments in the 6 to 25 MV beam energy range. The model has been tested on measured data from multiple treatment machines and techniques, and is broadly applicable to contemporary external beam radiation therapy.

OUT-OF-FIELD DOSE MEASUREMENTS FOR 3D CONFORMAL AND INTENSITY MODULATED RADIOTHERAPY OF A PAEDIATRIC BRAIN TUMOUR.

The purpose of this study was to measure out-of-field organ doses in clinical conditions in anthropomorphic paediatric phantoms which received a simulated treatment of a brain tumour with intensity modulated radiotherapy (IMRT) and 3D conformal radiotherapy (3D CRT). Organ doses measured with radiophotoluminescent and thermoluminescent dosemeters were on average 1.6 and 3.0 times higher for the 5 y-old than for the 10 y-old phantom for IMRT and 3D CRT, respectively. A larger 5-y to 10-y organ dose ratio for 3D CRT can be explained because the use of a mechanical wedge for the 5-y-old 3D CRT phantom treatment increased out-of-field doses. Due to different configurations of the radiation fields, for both phantoms, the IMRT technique resulted in a higher non-target brain dose and higher eye doses but lower thyroid doses compared to 3D CRT. For 3D CRT (which used a non-coplanar field configuration), eye doses were 3-6% and for IMRT (which used a coplanar field configuration) 27-30% of the treatment dose, respectively. For thyroid and more distant organs, doses were less than 1% of the treatment dose. Comparison of measured doses and doses calculated by the treatment planning system (TPS) showed that the TPS underestimated out-of-field doses both for IMRT and 3D CRT.

Application of dosimetry systems and cytogenetic status of the child population exposed to diagnostic X-rays by use of the cytokinesis-block micronucleus cytome assay.

Low-dose ionizing radiation used for medical purposes is one of the definite risk factors for cancer development, and children exposed to ionizing radiation are at a relatively greater cancer risk as they have more rapidly dividing cells than adults and have longer life expectancy. Since cytokinesis-block micronucleus cytome (CBMN Cyt) assay has become one of the standard endpoints for radiation biological dosimetry, we used that assay in the present work for the assessment of different types of chromosomal damage in children exposed to diagnostic X-ray procedures. Twenty children all with pulmonary diseases between the ages of 4 and 14 years (11.30 ± 2.74) were evaluated. Absorbed dose measurements were conducted for posterior-anterior projection on the forehead, thyroid gland, gonads, chest and back. Doses were measured using thermoluminescence and radiophotoluminescent dosimetry systems. It was shown that, after diagnostic X-rays, the mean total number of CBMN Cyt assay parameters (micronucleus, nucleoplasmic bridges and nuclear buds) was significantly higher than prior to diagnostic procedure and that interindividual differences existed for each monitored child. For the nuclear division index counted prior and after examination, no significant differences were noted among mean group values. These data suggest that even low-dose diagnostic X-ray exposure may induce damaging effect in the somatic DNA of exposed children, indicating that immense care should be given in both minimizing and optimizing radiation exposure to diminish the radiation burden, especially in the youngest population.

Primary DNA damage assessed with the comet assay and comparison to the absorbed dose of diagnostic X-rays in children.

The aim of this work is to assess DNA damage in peripheral blood lymphocytes of children prior to and following airway X-ray examinations of the chest using the alkaline comet assay and to compare data with the measured absorbed dose. Twenty children with pulmonary diseases, between the ages of 5 and 14 years, are assessed. Absorbed dose measurements are conducted for posterior-anterior projection on the forehead, thyroid gland, gonads, chest, and back. Doses are measured using thermoluminescent and radiophotoluminescent dosimetry systems. Differences between tail lengths, tail intensity, and tail moments as well as for the long-tailed nuclei before and after exposures are statistically significant and are dependent on the individual. The results demonstrate the usefulness of the comet assay as a measure of X-ray damage to lymphocytes in a clinical setting. Doses measured with both dosimeters show satisfactory agreement (0.01 mSv) and are suitable for dosimetric measurements in X-ray diagnostics.

TL detectors for gamma ray dose measurements in criticality accidents.

Determination of gamma ray dose in mixed neutron+gamma ray fields is still a demanding task. Dosemeters used for gamma ray dosimetry are usually in some extent sensitive to neutrons and their response variations depend on neutron energy i.e., on neutron spectra. Besides, it is necessary to take into account the energy dependence of dosemeter responses to gamma rays. In this work, several types of thermoluminescent detectors (TLD) placed in different holders used for gamma ray dose determination in the mixed fields were examined. Dosemeters were from three different institutions: Ruder Boskovic Institute (RBI), Croatia, JoZef Stefan Institute (JSI), Slovenia and Autoridad Regulatoria Nuclear (ARN), Argentina. All dosemeters were irradiated during the International Intercomparison of Criticality Accident Dosimetry Systems at the SILENE Reactor, Valduc, June 2002. Three accidental scenarios were reproduced and in each irradiation the dosemeters were exposed placed on the front of phantom and 'free in air'. Following types of TLDs were used: 7LiF (TLD-700), CaF2:Mn and Al2O3:Mg,Y-all from RBI; CaF2:Mn from JSI and 7LiF (TLD-700) from ARN. Reported doses were compared with the reference values as well as with the values obtained from the results of all participants. The results show satisfactory agreement with other dosimetry systems used in the Intercomparison. The influence of different types of holders and applied corrections of dosemeters' readings are discussed.

[Secondary Standard Dosimetry Laboratory at the Ruder Boskovic Institute, Zagreb]. / Sekundarni standardni dozimetrijski laboratorij Instituta "Ruder Boskovic", Zagreb.

The Secondary Standard Dosimetry Laboratory at the Ruder Boskovic Institute (SSDL), Zagreb, Croatia, was set up over the last few years with a strong support by the International Atomic Energy Agency (IAEA) through the Technical Cooperation Project CRO/1/004, Establishing Calibration Services. The SSDL occupies two calibration rooms, each 9.6 m long and 6 m wide and each with proper air conditioning. Their walls are concrete and 1 m thick, and the entrance doors are plated with lead to protect the control rooms and the surroundings against radiation. In the first calibration room in the basement, there are two sealed sources which share the same, 6 m long calibration bench. A 30 TBq 60Co source on one side of the bench is used for calibrating ionising chambers and other high-dose radiation equipment. The irradiation unit on the other side of the bench combines two sealed sources, that is, a 740 MBq 137Cs source and a 185 MBq 60Co source, and is used for radiation protection purposes. It has three attenuators with nominal attenuations of x10, x100, and x1000. The second calibration room, which is just above the first, accommodates an X-ray unit (ISOVOLT 420, 40 kV to 300 kV, 1 mA to 20 mA) with a 5 m long calibration bench, aperture wheel assembly designed to modify the X-ray beam diameter to meet various configuration requirements for calibration instruments, a set of filter assemblies to control beam definition according to ISO 4037-3, and a half-value layer kit.

Chemical dosimetry system for criticality accidents.

Ruder Boskovic Institute (RBI) criticality dosimetry system consists of a chemical dosimetry system for measuring the total (neutron + gamma) dose, and a thermoluminescent (TL) dosimetry system for a separate determination of the gamma ray component. The use of the chemical dosemeter solution chlorobenzene-ethanol-trimethylpentane (CET) is based on the radiolytic formation of hydrochloric acid, which protonates a pH indicator, thymolsulphonphthalein. The high molar absorptivity of its red form at 552 nm is responsible for a high sensitivity of the system: doses in the range 0.2-15 Gy can be measured. The dosemeter has been designed as a glass ampoule filled with the CET solution and inserted into a pen-shaped plastic holder. For dose determinations, a newly constructed optoelectronic reader has been used. The RBI team took part in the International Intercomparison of Criticality Accident Dosimetry Systems at the SILENE Reactor, Valduc, June 2002, with the CET dosimetry system. For gamma ray dose determination TLD-700 TL detectors were used. The results obtained with CET dosemeter show very good agreement with the reference values.